Of the people charged, 26 have been arrested or expected to surrender and four are known to have fled to Cuba. Three have not been found and are considered fugitives, United States Attorney’s Office for the Southern District of Florida said.

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A total of 33 people in Miami-Dade and Palm Beach counties were charged for staging car crash and submitting false medical insurance claims through the chiropractic clinics they controlled, authorities said Thursday.

Of the people charged, 26 have been arrested or expected to surrender to authorities, four are known to have fled to Cuba. Three have not been found and are considered fugitives, United States Attorney’s Office for the Southern District of Florida said in a statement.

A total of 21 clinics participated in the scheme. The owners of chiropractic clinics allegedly recruited people who had medical or chiropractic licenses, as required by the state to open a clinic, to act as “nominee owners” of the clinics, authorities said.

They then recruited people who participated in the car crash, and other people to help the clinics launder the insurance proceeds, authorities said.

“If you get upset about your car insurance premiums going up, this crime is one of the reasons why,” William J. Maddalena, Assistant Special Agent in Charge of FBI Miami, said in the statement.

Complicit chiropractors and therapists were also hired to prescribe and bill for unnecessary treatments and services that had not been rendered, authorities said.

“Thereafter, complicit clinic employees prepared and submitted claims to the automobile insurance companies for payment for these unnecessary or non-rendered services,” the statement said.

The staged crashes took place between October 2006 and December 2012 have resulted in court-ordered restitution of more than $5 million to the defrauded insurance companies. To date, 92 people have been charged to date in Operation Sledgehammer I-VI.